Room: Track 4
Purpose: Targeting small, breast lesions with high accuracy is critical for early stage diagnosis, treatment planning, and improving patient prognosis. Current anatomical image-guided biopsy methods are limited in sensitivity and targeting accuracy, especially for women with dense breasts. We propose a positron emission mammography (PEM) ultrasound (US)-guided biopsy workflow, to combine functional-based target localization with real-time anatomical detail to improve guidance for tumour sampling. This work presents the development and validation a mechatronic needle-tracking system for PEM and US-guided breast biopsy.
Methods: A mechatronic needle-tracking system was developed to operate with an advanced PEM and US imaging system. The system features a manually operated, mechatronic guidance arm with ability to access the breast between PEM detector plates. The end-effector is a biopsy device containing an integrated US transducer and biopsy gun with its needle focused on a remote-center-of-motion. Custom software modules were developed to track, display, and guide the biopsy device. Guiding the needle to calibration fiducials on a simulated PEM detector plate registered the coordinate systems using landmark-based registration. Validation was performed with fiducials at various locations within the targeting volume of a breast between detector plates, simulating PEM detected lesions. Fiducial Registration Error (FRE) and Target Registration Error (TRE) were quantified to evaluate accuracy. Within 95% confidence intervals, 3D principal component analysis assessed directional trends.
Results: Registration and validation resulted in an FRE of 0.23±0.20mm (N=8) and TRE of 0.70±0.20mm (N=72). A 3D prediction ellipsoid, centered on the mean targeting error, demonstrates the ability to successfully target within a spherical region <2mm in diameter with 95% confidence.
Conclusions: We demonstrate accurate, dynamic needle-tracking with sub-millimeter guidance error within the 3D targeting region of a breast between simulated PEM detector plates. Our mechatronic system demonstrates potential to improve targeting accuracy as a novel means toward image-guided breast biopsy.
Funding Support, Disclosures, and Conflict of Interest: Funding supported by the Ontario Institute for Cancer Research (OICR) and the Canadian Institutes of Health Research (CIHR). C Park is supported by the Natural Sciences and Engineering Research Council (NSERC) of Canada, and the Translational Breast Cancer Research Unit funded by the Breast Cancer Society of Canada.
Positron Emission Mammography, Image Guidance, Validation
IM- Multi-Modality Imaging Systems: Development (new technology and techniques)